From the Guidelines
The recommended antibiotic treatment for epiglottitis is a third-generation cephalosporin, such as ceftriaxone (1-2g IV every 24 hours) or cefotaxime (1-2g IV every 6-8 hours), typically administered for 7-10 days, as supported by the most recent guidelines 1. This recommendation is based on the need to target the most common causative organisms of epiglottitis, including Haemophilus influenzae, Streptococcus pneumoniae, and Streptococcus pyogenes.
- The choice of antibiotic should be guided by the severity of the infection and the patient's allergy history.
- For patients with severe penicillin allergy, alternatives include levofloxacin (750mg IV daily) or clindamycin (600-900mg IV every 8 hours) plus a third-generation cephalosporin if the patient can tolerate it, as suggested by the guidelines 1.
- Treatment should be initiated immediately after securing the airway, as epiglottitis is a medical emergency that can lead to rapid airway obstruction.
- Blood cultures should be obtained before starting antibiotics, but treatment should not be delayed, emphasizing the importance of prompt intervention 1.
- Once clinical improvement occurs and the patient can swallow safely, typically after 24-48 hours, therapy can be switched to oral antibiotics to complete the course, allowing for a more convenient and less invasive treatment approach. Key considerations in the management of epiglottitis include:
- Securing the airway to prevent obstruction
- Initiating antibiotic therapy promptly
- Monitoring for clinical improvement and adjusting treatment as needed
- Completing the full course of antibiotics to ensure resolution of the infection, as highlighted in the guidelines 1.
From the Research
Recommended Antibiotics for Epiglottitis
The following antibiotics are recommended for the treatment of epiglottitis:
- Ceftriaxone, a third-generation cephalosporin, which has been shown to be effective in treating epiglottitis with a short course of two doses 2 or as a single daily dose for 5 days 3
- Sulbactam/ampicillin, which has been evaluated as a safer and equally effective alternative to chloramphenicol/ampicillin therapy for acute epiglottitis in infants and children 4
- Third-generation cephalosporins, such as cefotaxime, which are preferred for upper respiratory infections like epiglottitis due to their safety profile and effectiveness against Enterobacteriaceae 5
Key Findings
- Ceftriaxone has been shown to have a wide antibacterial spectrum and is effective against Haemophilus influenzae type b, the most common cause of epiglottitis 2, 3, 6
- Sulbactam/ampicillin is effective against beta-lactamase-producing Haemophilus influenzae type b, which is resistant to ampicillin alone 4
- Third-generation cephalosporins, including ceftriaxone, have been found to be safe and effective in treating epiglottitis, with few adverse effects 5, 6